Renal: Hypo- or Hyperkalemia Treatment

Question 1

MOA of spironolactone

Answer 1

Competitive aldosterone antagonist

• decreases reabsorption of Na and water
• -lowers BP

Also antagonizes pro-fibrotic effect of aldosterone

Question 2

Adverse effects of spironolactone?

Answer 2

Hyperkalemia

Amenorrhea, hirsuitism, gynecomastia, impotence

Tumorigen

Question 3

MOA of Furosemide?

Answer 3

NKCC blocker, so water will follow

-lowers fluid, therefore lowers preload and BP and edema

Question 4

Where do loop diuretics work?

Answer 4

Thick ascending loop of Henle

Question 5

Clinical applications of Furosemide

Answer 5

Loop diuretic for edema in:
-HF, cirrhosis, renal issues**

Lowers preload and BP

Question 6

Adverse effects of furosemide?

Answer 6

Loss of electrolytes (K, Na, Ca, Mg)

Hyperglycemia, Hyperuricemia

Ototoxic!*
-vertigo, tinnitus

Sulfa drug*

Question 7

What can be given as a loop diuretic in those w a sulfa allergy?

Answer 7

Ethacrynic acid

Question 8

What can be given with loop diuretics to prevent hypokalemia?

Answer 8

K+ sparing diuretics

-spironolactone

Question 9

What class of diuretics loses the least amount of bicarb?

Answer 9

Loop diuretics

Question 10

Hydrochlorothiazide MOA

Answer 10

Blocks NaCl cotransporter at distal tubule

-decreases Na and Water absorbed to lower BP

Question 11

What is an off label use of Hydrochlorothiazide

Answer 11

Calcium nephrolithiasis

-counters loss of Ca+

Question 12

Adverse Effects of Hydrochlorothiazide

Answer 12

Loss of electrolytes (K, Na, Mg)

Hyperglycemia, Hyperuricemia

Sulfa drug*

Question 13

MOA of Amiloride

Answer 13

Blocks sodium (ENaC) channels at collecting duct

Question 14

Is amiloride K+ sparing or losing?

Answer 14

Sparing

-counteracts K+ loss

Question 15

Adverse effects of amiloride?

Answer 15

Hyperkalemia
Hyponatrema

hyperchloric metabolic acidosis

Question 16

Should you mix herbal diuretics with conventional diuretics?

Answer 16

No, could have potentiating effects

Question 17

How can licorice cause an increase in BP?

Answer 17

Contains glycyrrhizic acid

-potentiates aldosterone effects in the kidney

Question 18

Pt comes in with lethargy and drowsiness. Strength is +3/5 in all extremitiees. They are hypotensive and have U waves with flattened T waves on ECG. Hyper or hypokalemia?

Answer 18

Hypokalemia

Question 19

If you are wanting to raise an acute hypokalemia by 0.27mEq/L, how many mEq/L of K+ would you need to give?

Answer 19

100mEq K+

-need a lot to raise a little

Question 20

If you are wanting to raise a chronic hypokalemia by 1 mEq/L, how many mEq/L of K+ would you need to give?

Answer 20

200-400mEq K+

-a larger increase seen in chronic!

Question 21

If pt is severely hypokalemic, how would you treat them?

Answer 21

IV K+

-10-20 mEq/hour

Question 22

What should your patients do when taking K+ to avoid GI upset?

Answer 22

Drink with 1/2 glass of water

Question 23

Pt comes in w HR of 35, they have peaked T waves and a widened QRS. They are weak and have some flaccid paralysis. Dx?

Answer 23

Hyperkalemia

Question 24

How do you treat hyperkalemia? (3 Steps)

Answer 24

1. Give Calcium Glucaronate
   - to protect the heart
2. Give Insulin and Glucose
   - -B2 agonists also work
3. Dialysis or give something to facilitate K+ excretion
   - thiazide
   - mineralcorticoid (if hypoaldosteronism)
   - cation exchange resin